Kelepouris N, Harper K D, Gannon F, Kaplan F S, Haddad J G
Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania School of Medicine, Philadelphia 19104-6149, USA.
Ann Intern Med. 1995 Sep 15;123(6):452-60. doi: 10.7326/0003-4819-123-6-199509150-00010.
To evaluate men with severe osteoporosis for pathogenetic factors and to review the reported features of primary osteoporosis in men.
Case series and clinical review.
47 men consecutively referred to a metabolic bone center because of atraumatic (or minimally traumatic) fractures (91%) or radiographic osteopenia (9%).
Clinical assessment, radiographs, chemical analyses of serum and urine, hormone assays, skeletal densitometry, and histomorphometry of iliac crest biopsy specimens.
27 of the 47 men (57%) had vertebral fractures, and 16 (34%) had appendicular fractures. Causal factors identified in 30 men (64%) included glucocorticosteroid treatment (8 men); hypogonadism (7 men); excessive alcohol consumption (7 men); and anticonvulsant use, osteomalacia, severe hyperthyroidism, or bone marrow neoplasia (8 men). Seventeen men (36%) had no medical conditions or known risk factors associated with bone disease. Spinal mineral density was well below the mean value for healthy young men in 94% of the patients with primary osteoporosis tested. Examination of biopsy specimens from 13 of 17 men with primary osteoporosis showed reduced trabecular bone volumes, normal bone formation rates, and slightly increased resorption surfaces. Fasting hypercalciuria was seen in some men (41%). In the primary osteoporosis group, eight men were followed serially (range of follow-up, 6 months to 9 years) while they were receiving a nonpharmacologic regimen (diet and activity); the mean axial bone mineral density of these men increased slightly.
A thorough evaluation for identifiable causes of severe osteoporosis in men is warranted because definable pathogenetic factors are seen in many cases. A few men with severe osteoporosis have primary or idiopathic osteoporosis. Primary osteoporosis in men is probably caused by many factors because heterogeneous clinical, laboratory, and histologic features were seen in our series and in those of others. Further studies of primary osteoporosis are needed to define the course of the disease, to identify pathogenetic mechanisms, and to develop therapeutic interventions.
评估重度骨质疏松男性患者的致病因素，并回顾已报道的男性原发性骨质疏松的特征。
病例系列研究及临床综述。
47名因非创伤性（或轻微创伤性）骨折（91%）或X线骨质减少（9%）而连续转诊至代谢性骨病中心的男性。
临床评估、X线片、血清和尿液化学分析、激素测定、骨密度测定以及髂嵴活检标本的组织形态计量学分析。
47名男性中，27名（57%）有椎体骨折，16名（34%）有四肢骨折。在30名男性（64%）中确定的致病因素包括糖皮质激素治疗（8名）；性腺功能减退（7名）；过量饮酒（7名）；以及使用抗惊厥药、骨软化症、重度甲状腺功能亢进或骨髓肿瘤（8名）。17名男性（36%）没有与骨病相关的疾病或已知危险因素。在接受检测的原发性骨质疏松患者中，94%的患者脊柱骨密度远低于健康年轻男性的平均值。对17名原发性骨质疏松男性中的13名进行活检标本检查，结果显示骨小梁体积减少、骨形成率正常、吸收表面略有增加。部分男性（41%）出现空腹高钙尿症。在原发性骨质疏松组中，8名男性在接受非药物治疗方案（饮食和运动）期间接受了连续随访（随访时间为6个月至9年）；这些男性的平均轴向骨密度略有增加。
鉴于许多病例中可明确致病因素，因此有必要对男性重度骨质疏松的可识别病因进行全面评估。少数重度骨质疏松男性患有原发性或特发性骨质疏松。男性原发性骨质疏松可能由多种因素引起，因为在我们的系列研究以及其他研究中均观察到了异质性的临床、实验室和组织学特征。需要对原发性骨质疏松进行进一步研究，以明确疾病进程、确定致病机制并制定治疗干预措施。
